Multiple choice questions: ANSWERS Chapter 1. Redefining Parkinson s disease 1. Common non-motor features that precede the motor findings in Parkinson s disease (PD) include all of the following except? d. Dementia 2. Is the following statement correct? Hyposmia usually occurs after tremor begins in PD: b. False 3. Genetic mutations in PD may be considered prephysiologic biomarkers: a. True 4. Which sleep disorder appears to be a synucleinopathy? b. REM sleep behavior disorder 5. Disease-modifying treatment probably needs to be started before motor symptoms of PD occur because? c. Once motor symptoms are present degeneration is probably too far along for disease-modifying treatment to be effective Chapter 2. Motor features of Parkinson s disease 1. Which of the following is a cardinal motor feature of PD? b. Postural instability 2. Which of the following is true regarding the re-emergent tremor in PD? a. It occurs after a variable latency when the arms are outstretched or in posture For reprint orders, please contact: reprints@futuremedicine.com 2013 Future Medicine Ltd 141
3. Motor decrement may manifest as: c. Reduction in amplitude of a finger tap 4. Which of the following is not considered a risk factor for motor fluctuations and dyskinesias? d. History of stroke 5. Diphasic dyskinesias: b. May be associated with a prominent dystonic component Chapter 3. Olfaction, pain and other sensory abnormalities in Parkinson s disease 1. In Parkinson s disease (PD) restlessness during nocturnal sleep is likely to be due to: 2. In PD pain: e. Can be a prodromal symptom and can lead to misdiagnosis 3. The following symptoms may present as common features of non-motor fluctuation: 4. Olfactory dysfunction in PD: 5. Similar to PD olfactory impairment can be found in: d. Alzheimer disease and DLB Chapter 4. Cognitive and behavioral abnormalities in Parkinson s disease 1. Overlapping signs of Parkinson s disease (PD) and psychiatric disturbances do not include: c. Delusions 2. Depressive disorders: e. Are all of the above 3. Which of the the following class of medications is associated with delirium in PD? b. Anticholinergic 142
Multiple choice questions: answers 4. Across multiple studies, the cross-sectional prevalence of depressive disturbances has been found to be approximately: c. 40% 5. Treatment of impulse control disorder (ICDs) includes all of the following except: e. Pramipexole and ropinirole 6. Which of the following is not true of depressive disorders in PD: c. They are associated with need for lower doses of antiparkinsonian medications 7. Which of these are not classified as an anxiety disorder: c. Schizophrenia 8. Which of the following pairs of medications are recommended to treat psychosis in PD: d. Clozapine and quetiapine 9. A cognitive behavior therapy program for treatment of depression in PD might include all of the following modules except: d. Joke-telling 10. Randomized, placebo-controlled trials of antidepressant medications to treat depression in PD have demonstrated the efficacy of all of the following except: d. Fluoxetine Chapter 5. Autonomic dysfunction in Parkinson disease 1. The blood pressure (BP) and heart rate (HR) responses to the Valsalva maneuver reflect changes in autonomic nervous system activity. The normal hemodynamic response to the Valsalva maneuver does not include: d. Fall in BP during Phase IV 2. In patients with Parkinson s disease (PD) and neurogenic orthostatic hypotension the Valsalva maneuver shows: c. No overshoot in BP during Phase IV 3. Midodrine is a pressor agent approved by the US FDA for the treatment of neurogenic orthostatic hypotension. Mididorine is: a. A peripheral a1 agonist 143
4. Protein aggregates forming Lewy bodies are seen in neuropathologic studies of peripheral autonomic nerves and autonomic ganglia of patients with PD, dementia with Lewy bodies and pure autonomic failure. What is the main protein found in Lewy bodies? b. a-synuclein 5. Several medications can trigger or worsen orthostatic hypotension in susceptible patients. The most common are: 6. Ambulatory monitoring involves intermittent recordings of BP (and HR) during 24 h both while the patient is awake and asleep. Normally, there is a fall in both BP and HR at night during sleep. In patients with PD and impaired autonomic reflexes this night-time dipping is frequently: b. Absent 7. Diagnostic criteria for orthostatic hypotension are: a. A fall in systolic BP of at least 20 mmhg and/or diastolic BP of at least 10 mmhg within 3 min of standing 8. Symptoms of orthostatic hypotension are often worse at specific times of the day or after particular activities. These include: 9. A 75-year-old male recently diagnosed with PD complained of urinary frequency and weak stream as well as influenza-like symptoms. He visited three doctors the day before and was prescribed three new medications. He was taken to the ER owing to a brief episode of loss of consciousness when he got up at night to urinate. On questioning, he previously had occasional episodes of lightheadedness when standing for prolonged periods at church or when gardening on a hot day. Which new medications are the probable cause of his episode of loss of consciousness a. Tamsulosin by his urologist Chapter 6. Biomarkers for Parkinson s disease 1. According to the NIH Biomarker Working Group, in order for a biomarker to be considered a surrogate end point, it must: c. Predict the clinical benefit or harm that would be observed on a valid clinical end point 144
Multiple choice questions: answers 2. A trait biomarker measures a characteristic that: a. Does not change over time, such as a genetic variation 3. Single-photon emission computed tomography imaging of the dopamine transporter is useful for: b. Identifying conditions that produce dopamine deficiency including Parkinson s disease and multiple system atrophy 4. One type of MRI that may be useful in the diagnosis of Parkinson s disease is: d. Diffusion tensor imaging 5. Measurement of a-synuclein is possible in all of the following tissues except: b. Hair Chapter 7. Animal models of Parkinson s disease 1. Parkinson s disease (PD) animal models are used to: 2. Animal models of PD are evaluated by: d. Combination of behavioral, biochemical and pathologic assessments 3. 1-methyl-4-phenyl 1,2,5,6-tetra-hydro-pyridine is a neurotoxin that: a. Can cause parkinsonism in humans and primates 4. 6-hydroxydopamine lesions animal models of PD are mostly produced: b. By unilateral injection of 6-OHDA in the medial forebrain bundle of a rat 5. Currently developed genetic models: 145